Ask a Physio

Hi Peter, I understand your concerns especially being so close to the event. It sounds like the calf has become overloaded. From your description it’s hard to know if it is the tendon or muscle. However, my advice would be:
- Use discomfort as a guide to how much you can exercise – No more than 3/10 pain during or after. This should resolve the next day.
- Reduce your training load so the calf has minimal irritability – less runs or less distance. Once calf has settled gradually increase load to only 1 run per week ( don’t increase load and frequency at the same time).
- Ensure to add a warm up prior to running due to the colder weather.
- Walking and cycling can be a good ways to keep your fitness however it still requires a lot of calf demand so monitor load during those.
- Incorporate some calf strengthening during the week – Double leg and single leg calf raises on non-running days. You can do raises through range or incorporate some holds to add more tension into the tendon
- Stretching/Massaging the calf and other muscles of the lower limb can be helpful. When stretching make sure its pain free.

Hope these tips have been helpful. If symptoms don’t change I recommend you seek further advise from a local physio. All the best for the Marathon.

Kind Regards

Denise Garcia
Physiotherapist – Macquarie St

“This is general advice only & shouldn’t take the place of a consultation with your healthcare provider. For private consultation with our expert team of physiotherapists or massage therapists, please contact Sydney Physiotherapy Solutions on 9252 5770 or sydneyphysiosolutions.com.au “

Hi Brad, Im running the Blackmores Marathon and up until a week ago training was going well. For three consecutive weeks I had run circa 25km long runs. However, out of no-where I've just had this niggle develop in my inner calf muscle (perhaps the medial gastrocnemius?) I rested it for a week, and then tried easing back in (a long walk, a bike ride), but its inflammed again. It only feels like a small niggle - not sure how long I need to rest for to make sure it gets better. If I rest it too long, ill lose my fitness, if I reinjure it again in a week, thats no good either. Any advice you have would be appreciated.

Hi Brad and team,
I'm 31yo, run generally a few times a week (often not terribly far), and walk at least a few km every day getting to work, but sometimes in the morning as I get out of bed I get searing pain under my right foot around where the heel would come in contact with the ground if not wearing shoes (so not directly beneath the heel bone, but in the softer tissue just surrounding that, particularly near the middle of the foot). I have a sneaking feeling it started after playing a social game of indoor soccer about 2 months ago... I have added inserts into my every-day shoes to help cushion my heel for walking (helps a little), and massaging seems to help it, but I was hoping there might be a more long-term solution to stop the pain from coming back. It doesn't hurt when I run, and only occasionally when I walk. Any tips would be most welcome!
Another thing is I get a feeling of tightness/insecurity behind my right knee sometimes when I run. Could this simply be a lack of flexibility that is now compromising my muscle strength and feeling of muscle security? Also (and/or) could starting ballet classes earlier this year be a contributing factor (all that pointing of toes..)? (I really enjoy ballet class, so I'm keen to work out how to continue both running and ballet without pain)
Are there any strength or stretching exercises (or other things) that might be good for either of these concerns? Thank you in advance for any help you may be able to provide!
Cheers,
Helen

Hi Brad
I seem to have developed tendonitis in my Achilles. What would you suggest as a recommendation for treatment & to avoid further instances?
Thanks for your advice
James

Hi Brad

I started running 12 months ago (at 50 yo), completing a couple of half marathons and shorter races. This year, I have been training for my first full marathon and have developed a problem with a very sore Achilles tendon, so much so that I stop running for a week or two a couple of times, without success and have just started running again after a 2 month break to try and recover - after a couple of short runs (4 & 6 km) over 4 days, there is some soreness but very minor. The problem seems to arise after I cool down and seems to coincide with tight hamstrings, the next day. I have not changed anything I do, compared to last year, other than having a slight lower back strain in January, after some water skiing.

Would more stretching help this or will I just need to rethink my ability to run longer distances, if so, what stretches should I do before and after running (I have typically not been a great stretcher, so I would appreciate assistance)

Hi Karen,

Sorry to hear your feet are getting in the way of your training! It’s quite a common complaint with runners and there can be several causes and solutions.

One of the first things to consider if you are having this problem is what footwear you are using (which you have already thought of – well done!). When thinking about what running shoes to choose, you need to consider the following:
• The correct size: Our feet naturally heat up and swell during exercise, so if there isn’t enough room your circulation can be restricted and there can be increased friction on your skin, leading to burning pain and blisters.
• Laces: A common mistake we make is doing them up too tightly which can also restrict circulation or irritate the nerves in your foot. Check to see if you have some wiggle room under the knot and across the front of your foot. Perhaps when the burning sensation kicks in during your run you can try to loosen the laces and see if that reduces the pain?
• Cushioning and Insoles: If you are aiming to up the mileage, you might need to consider shoes that have slightly more cushioning under the balls of the feet and the quality of the insole in the shoe
• Socks: As your feet will sweat while running, make sure you have moisture wicking socks that will aid in keeping your feet cool (cotton is not good for this!).

However, if you have already tried these options with your shoes/socks and haven’t noticed a difference, there are several other things to consider:
• Running technique: There are many components to your running technique which, if not executed correctly, can lead to overloading of the tissues in your feet. In the clinic we can perform a Running Assessment where we video you and see if there are any changes we can help you make.
• Muscle imbalance: Tight calves, poor arch control, poor hip/knee/ankle stability are just a few areas which could also contribute to your problem.
• In some cases, burning pain can be an indicator that there is some nerve irritation, such as Morton’s Neuroma, which isn’t cancerous but can be quite painful!

Karen, I recommend seeking an assessment from a Health Professional. If you only experience this pain when trying to increase your running duration, not at any other time during your day, I would be inclined to suggest seeing a physiotherapist first who can look at your lower limb and foot, as well as your running technique. If you have a history of foot pain prior to this, or during activities other than running, then a Podiatrist would be a great option.

I hope this helps and you can get past that 50-minute mark with your running soon!

Warm regards,

Talia Kruger
Physiotherapist
Sydney Physio Solutions Castlereagh St

“This is general advice only & shouldn’t take the place of a consultation with your healthcare provider. For private consultation with our expert team of physiotherapists or massage therapists, please contact Sydney Physiotherapy Solutions on 9252 5770 or sydneyphysiosolutions.com.au”

Hello, I pulled a calf muscle last week and it is still sore. I haven't exercised since then -should I continue to rest or is it ok to run?
Thanks for your advice
Geoff

Dear Brad and team,

I am very prone to getting blisters and hot spots on the balls of my feet (under the big toe and to the side) which makes running quite painful at times, and is really getting in the way of my training and increasing my mileage. This area of my foot usually starts to burn at around 35min and I can usually make it to 50min before needing to stop, but I can't go further. I've tried different types of shoes and yet continue to experience the same issue. Would you recommend that I see a podiatrist and is this simply related to not wearing the right shoes?

Any advice you could offer would be much appreciated

Thanks so much, Karen